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General NPI Number Information
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NPI Number | 1629357868
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Entity Type | Organization
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Legal Business Name | MICHAEL D MIXON MDPA
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 1213 DARTMOUTH CIR
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City | MURPHY
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State | TX
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Zip | 75094-4112
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Country | US
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Telephone | 214-703-3764
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 941
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City | WYLIE
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State | TX
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Zip | 75098-0941
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL D MIXON
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Credential | MD
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Telephone | 214-703-3764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J1317
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License Number State | TX
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